Nilsagård Ylva Elisabet, Smith Daniel Robert, Söderqvist Fredrik, Strid Emma Nilsing, Wallin Lars
University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.
Department of Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.
Implement Sci Commun. 2025 Apr 7;6(1):36. doi: 10.1186/s43058-025-00723-y.
Evidence-based healthcare recommendations exist for tobacco use, harmful alcohol consumption, low physical activity, and poor diet. However, the uptake of these recommendations in Swedish primary healthcare is poor, and the potential benefits for patients are not fully realized. Our aim was to evaluate the effect (i.e. the uptake) of a 12-month multifaceted implementation strategy to achieve a more health-promoting practice. We hypothesized that primary healthcare centers receiving this strategy would increase and sustain their health-promotion practices to a significantly greater extent than control centers, from baseline to the 6-month follow-up.
In a non-randomized parallel group study, 5 intervention centers and 5 matched control centers were compared regarding health-promotion activities delivered in relation to visits to each center. The intervention centers received a multifaceted implementation strategy over at least 12 months based on established strategies, the Astrakan model of leading change, and findings from pre-implementation studies. The main strategies were: using external and internal facilitators to combine bottom-up and top-down perspectives, and emphasizing leadership responsibility for change. Medical record data on health-promotion activities, including prescribed physical activity and use of lifestyle screening forms, were collected monthly for 2 years: 6 months before and after implementation, and during the implementation phase. The implementation strategy effect was estimated using generalized linear mixed models.
During the 12-month implementation phase, the intervention and control sites had 135 002 and 160 987 healthcare visits, respectively; conducted 8839 and 6171 health-promotion activities, respectively; and administered 2423 and 282 lifestyle screening forms, respectively. A statistically significant higher relative uptake rate of health-promotion activities was found in intervention sites compared to control sites after the implementation period compared to before. The effect increased during the active phase, with the intervention sites having on average 1.07 and 2.0 times the uptake rate of the control sites at 1 and 12 months, respectively; this effect was largely maintained during the 6-month post-intervention phase. A significant absolute effect, in terms of difference in predicted uptake per 1000 visits, was evident 7 months into the implementation phase.
This multi-faceted implementation strategy was successful in achieving a more health-promoting practice. (ClinicalTrials.gov ref: NCT04 799,860, 03/04/2021, https://clinicaltrials.gov/study/NCT04799860 ).
This study is part of the Act in Time project, registered at ClinicalTrials.gov on 4 March 2021 (ref: NCT04 799,860).
针对烟草使用、有害饮酒、缺乏体育锻炼和不良饮食，已有基于证据的医疗保健建议。然而，这些建议在瑞典初级医疗保健中的采纳情况不佳，患者可能获得的益处尚未得到充分实现。我们的目的是评估一项为期12个月的多方面实施策略在实现更有利于健康的医疗实践方面的效果（即采纳情况）。我们假设，从基线到6个月随访期，接受该策略的初级医疗保健中心在促进健康实践方面的增加和维持程度将显著高于对照中心。
在一项非随机平行组研究中，对5个干预中心和5个匹配的对照中心在与各中心就诊相关的健康促进活动方面进行了比较。干预中心基于既定策略、阿斯特拉坎引领变革模型以及实施前研究的结果，在至少12个月的时间里接受了多方面实施策略。主要策略包括：利用外部和内部促进者将自下而上和自上而下的观点结合起来，并强调变革中的领导责任。在两年时间里每月收集关于健康促进活动的病历数据，包括规定的体育活动和生活方式筛查表的使用情况：实施前6个月、实施期间以及实施后6个月。使用广义线性混合模型估计实施策略的效果。
在12个月的实施阶段，干预中心和对照中心的医疗就诊次数分别为135002次和160987次；分别开展了8839次和6171次健康促进活动；分别发放了2423份和282份生活方式筛查表。与实施前相比，实施期结束后，干预中心的健康促进活动相对采纳率在统计学上显著高于对照中心。在活跃阶段效果增强，干预中心在1个月和12个月时的采纳率分别平均为对照中心的1.07倍和2.0倍；在干预后6个月阶段，这种效果基本得以维持。在实施阶段7个月时，就每1000次就诊的预测采纳差异而言，出现了显著的绝对效果。
这一多方面实施策略成功实现了更有利于健康的医疗实践。（ClinicalTrials.gov注册号：NCT04 799,860，2021年4月3日，https://clinicaltrials.gov/study/NCT04799860 ）。
本研究是“及时行动”项目的一部分，于2021年3月4日在ClinicalTrials.gov注册（注册号：NCT04 799,860）。
